Basic Information
| Provider Information | |||||||||
| NPI: | 1518371202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLL | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1973 WASHINGTON VALLEY RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088362053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326671123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA10633700 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.